The Zimmermann Note

This has come up quite a bit amongst Republicans as their solution to the healthcare costs skyrocketing and I thought I would offer my thoughts here. Tort reform is the idea that limiting caps on insurance settlements will in fact reduce costs. The argument is that by limiting caps, doctors will not be in the business of providing unnecessary tests and medical care i.e. act as “Defensive Doctors” for fear of being sued.

Tort Reform however, does not have many of the arguments of true conservatives, that being “Free Markets”, something that I find slightly odd and at the same time also find it odd that democrats do not support it either.

The total costs of malpractice is approximately 1-2% of total healthcare costs. I honestly believe that tort reform is necessary, however, my opinion is neither that of liberal or conservative viewpoints.

Costs associated with malpractice insurance will adversely affect certain specialties more often than others. For example, Obstetrics and Gynecology pays much more for malpractice insurance than your Internal Medicine physician.

However, even with Tort Reform, I do not believe that “Defensive Medicine” will become history. Fact is, doctors still do not like being sued. All it would do would be to lower the chances of outrageous liability suits occurring.  It might have some calming effects but it will not be the silver bullet either.

Tort Reform still does not answer the big issue with malpractice insurance in that one of the biggest costs of tort reform is the administrative and legal costs defending physicians. Just because a physician is being sued does not mean that the physician is liable, and in most cases these cases are either dropped or dismissed.  And because of these high costs, many times lawyers will not recommend to patients suing expecting lower settlements.

At the same time, with malpractice insurance rising, it is squeezing out certain specialties more than others. Also, we have to look at the situation where some states do not have the same insurance crisis as others might.

What I will argue and also find a bit humorous about the argument for Tort Reform is that it is not even ideologically based. Tort Reform is essentially having the government set up a “Regulated” market protecting physicians and and the health industry while not supporting the Legal Industry.  The common idea here is that its also a mandate to keep costs low for patients.

Next, we also have to realize that Insurance Companies are like large banks and they need a hefty amount of assets to stay afloat. Thus, investment income is a big component. They have shown that in situations when investment income takes a loss, that insurance rates rise due to the additional capital that needs to be undertaken to support malpractice claims.

So when investment income is high, the related costs for malpractice insurance will normally stay down but that in times when it is low malpractice insurance will rise in those states without caps but stay moderate in states where caps are in place.

Don’t you find this ironic? That the “Regulated” industry is being supported by conservatives that promote the “Free Market” system and liberals who do not?

The same time, this model would suggest that it is not the “Silver Bullet” which will lower costs but rather regulate them preventing the shocks within the malpractice market. I guess my message is that I would hope that liberals see that this is a good idea but to conservatives it is not the only idea.

Maybe to me, this is why I typically believe that you have to go beyond the talking points to find out the true story and in this case, I always find this funny because the argument here is more based upon what industries give to what party vs. actual ideology.  In this case they flipped.  Point being is that if you are a liberal democrat you can rest assured that this is okay.  I really do not think that suing a doctor for 10 million vs. 2 million will really make a difference. If the point is to send a message, it will get sent irregardless of the monetary amount.

However, in the long run I would really question whether lawsuits have a huge role in the Patient Care Model. This is also to liberals have a way of thinking that the best way to make sure nothing happens again is to punish and sue. (see Bush Administration War Crimes).  Yes, there will be situations where it will open eyes to current behavior but limits will not prevent this from happening.

Read as you may, and change your opinion as you may.

 

 

 

 

Last night my wife and I sat in front of the television watching MSNBC and the vote tally coming in. Choosing to not go through the desperate process of watching ‘CSPAN-type’debates and desperate politicians aiming for Prime Time television coverage we were able to turn it on at the perfect moment when the vote was being counted.

 

As the votes came in the shock of the moment has still not worn off. Healthcare for every single damn American is pretty much possible.

 

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When Alexander Hamilton began beginning the idea of writing the Federalist Papers, he did so with the idea that he needed to sell the American people the very idea of a “United States of America.” Hamilton was not totally dead set on the Constitution and had his doubts. The Constitution was a compromise clear and simple. It was a document aimed at creating a national government but at the same time providing a backdrop for individual states rights.

 

Hamilton, arguably the father of American Economics sought the idea that these United States become an empire like England, even preferring its structure of Monarchy but his opinions were overruled and never materialized among the larger Southern States.

 

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The very idea of a healthcare bill being passed was never an easy one. In an era of American life whereby we are provided a level of convenience in our daily lives, there were many that were impatient at the debates, the time and energy wasted debating this idea ad nauseum. For many of us we live in fear, fear for the health of ourselves and those that are closest to us.

 

If we are part of the “Haves” we might have quality healthcare. We have access to good doctors, we have fairly cheap rates and while a doctor visit might be unpleasant with unusual wait times, we thank our lucky stars that we are healthy.

 

We might be a senior. The parts don’t move as fluid as they used to. The tests are more difficult but at the end of the day, generally speaking, Medicare is not a bad plan.

 

And to the “Have Nots”, they might pay high premiums that offer very little protection, they might be students right out of college that have not received a job offer and are playing a game of Russian Roulette hoping their youth will prevent them any serious health issues or they are from an increasingly growing population that was denied healthcare because of pre-existing conditions, their coverage was halted because they got sick or at their place of employment they are not provided insurance.

 

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We think of the Constitution as a pretty unique and amazing document, providing a sound backdrop to our government. We can argue both on the left and right that people have a high regard for it and while it might be interpreted differently it has been used by liberals as well as Conservatives to provide a level of unalienable rights to citizens.

 

What Hamilton did with the help of James Madison and John Jay with the Federalist Papers was provide the idea of what our nation would look like, but also to calm fears to bring upon the difficulties of how the weak Articles of Confederation did not provide for the freedom and security necessary to act in unison with each other. By acting in unison, a future attack on South Carolina would be an attack on the entire United States and so forth

 

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I never thought of Obama as a true liberal but a moderate. His initial healthcare proposal for example was more “Conservative” in nature than the bill that was recently passed. If you remember the Presidential debates, it was Obamas intention that any public plan would not be deemed to be a mandate on the public, that is that the entire public did not have to buy into this proposal.

 

Sometimes we have to give credit to the black man born with the weird name to pass the largest piece of social legislation in decades.

 

Details of the bill here

 

http://www.cnn.com/2010/POLITICS/03/18/health.compromise.highlights/index.html

 

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Hamilton’s view of America did not shift after the Constitution was passed. Being brought on as the Secretary of the Treasury it was his intent that America create a National Bank to assume the debts of the States. Hamilton’s premise by doing this was  for several reasons including:  assuming state debts incurred during the Civil War it would bring upon nationalization of that debt and by doing so would make the nation stronger and prevent secession. He also looked at this as a mechanism that could be looked at by foreign countries. With the nation creating revenue streams they would also be allowed to provide aid to other countries on top of the idea of building up the United States. 

 

Many including Thomas Jefferson found the national bank unconstitutional. They found this notion dangerous and impeded on the states rights to act independently of the Federal Government.

 

And what we see from this battle even further is that this is the beginning of the fight for the interpretation of the Constitution. You have on one side of the aisle the Hamiltonians fighting for a broad interpretation of the Constitution vs. the Jeffersonians who were fighting for a strict interpretation of the Constitution.

 

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The fight for healthcare has often been about the idea that it is “Government Run” or “Socialized Medicine”. However, pitting the debate of healthcare into simple phrases such as this does not make to understand the depth of the problem of healthcare.

 

If you are a citizen such as myself a portion of your paycheck is deducted which is your employee policy cost. This is on top of the taxes as well as Medicare that is also deducted from your plan. And while there is an element of American life that distrusts the very idea of taxes, we have to remember that the cost of that healthcare plan that is being deducted from your paycheck inevitably pays not just the cost of care of you (and your family) but also contains an additional tax of all the benefits received from others that are uninsured, underinsured as well as other Medicare patients.

 

Think of it this way. You are out with some friends, 4 of whom are doing pretty good economically and successful and the other 4 which are struggling from week to week. Dinners great. You get a couple nice bottles of wine and party it up. . . until the check comes. You then realize that the 4 people cannot put in for all that they consumed and the four that are more economically well off end up paying for part of their dinner as well as their own.  So you end up getting less for what you paid for.

 

A conservative might find this unfair. Why should those that are in more affable positions have to pay for those that cannot afford it? Why should I as a consumer, a responsible citizen have to pay for the misfits?

 

We would then have to argue how is healthcare delivered. While it is true there is a handful that do make you upset. There are people out there trying to buck the trend. At the same time there are plenty of responsible and hard-working Americans that are not given the same benefits as the “Haves”. I believe that this bill tries to make things a bit more equal.

 

Consider the aspect of a young and healthy individual without insurance is injured, has to go to the ER and have major surgery. It is later realized that this individual cannot afford their bills and the hospital is forced to absorb those costs and those costs make prices rise for all patients which then incurs increases on the insurance end. There is no fault here. The healthy individual might not have had coverage with their employer, between jobs, out of college, etc.

 

By creating a mandate, i.e. that all citizens must carry a healthcare plan, we try to make that more equal. By paying into the system, there is a greater pool of resources available to the insurance companies. This is not a socialist program but a basic inherent belief that creating a mandate encourages all citizens that are not covered to participate.

 

The bill is similar to the “Romneycare” program enacted in Massachusetts by then Governor Mitt Romney.

 

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The arguments over Broad vs. Strict interpretation of the Constitution have been going on for years. Many “Tea Party” members point to the idea that it was never the intent of the Founding Fathers for our federal government to have so much power in our nations activities. My argument would that it would depend on the Founding Father.

 

Jefferson, for example, did not envision America as being a Superpower but of an agrarian society. And of course there are those that feel that these powers have shifted inordiantly and what you see among the Tea Party is this intent to remove many of the powers of the Federal Government. Historically speaking however, that is easier said than done.

 

Many Tea Partiers could probably blame Abraham Lincoln for this demise. Many controversially point to his decision to levy a war against the South and in doing so defied the Constitution. There is no doubt in my mind Lincoln’s actions shaped the Constitution differently than it had been in the past but I also believe that by doing so it made the nation stronger.

 

The New Deal and it’s policies also shifted many economic burdens over to the Federal Government during the Great Depression. But again, most economic professors would agree that during times of downturns, the Federal Government should be looked onto to stimulate the economy.

 

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Obamacare is not the New Deal. Hospitals are not being taken over by the government nor are insurance companies or pharmaceutical distributors. Instead, we can argue that the policies are very much based in conservative ideology including regulations.

 

Some might argue that our nation was founded on the idea of “Free Markets” and I would totally discredit that. “Free Markets” is a catchphrase used by conservatives to invoke the idea that capitalism=democracy. Our nation, even from it’s inception, regulated markets, corporations, etc. They understood the need to work with wealthy but never trusted it.

 

Consider a recall of a food product. Quite simply there is a concern about the safety of the product and if it is not safe we will take it out of the store. We cannot completely rely that the company that is producing the product is doing it in a safe manner and by setting up regulations we create that protection for consumers.

 

We might hope that the company acts in an ethical manner but in a true free market system they are truly on their own.  A good example for this is Chinese products which have received a high level of scrutiny over the past few years. China is a country that is dealing with these very issues as they have to understand that we want safe products.

 

Back to healthcare. If we live by the belief that “Free Markets” will solve the problem we forget the solution does not always cover all individuals. The healthcare package tries to address these problems with market-based approaches and without becoming too socialized.

 

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As I watched a bit of Fox News tonight and wondered aloud about how the other side will take this debate, I see a nation that is very polarized in nature. A bill such as Obamacare is moderate and truthfully speaking should have engaged some more moderate republicans to vote for it (if there are any left).

 

Their supposed cure of course is bringing this to the courts to battle it out. The new “In Vogue” amendment for Conservatives, replacing the 2^nd is the 10^th which reads:

 

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

 

This has essentially what the conservative movement has become, a complete denial of the Federal Government. Their best solution has in the words of Rick Perry is to secede. They are a bunch that finds it’s disciples in those that make them feel better about themselves. Their entertainers like Beck and Limbaugh who find ways to trample the weak. They are predominantly white and most likely not thinking in a manner that is relevant to public debate.

 

Using terms of hate, spitting on congressmen is not an example that I would hope we should be setting as a nation. Too often, as these debates persist, people too often busy to see what is going around them.

 

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When I flipped on my iPod this morning I went directly to the R.E.M. Political mix that I had created. Still in shock and awe from this moment, the band and the music seemed perfect for the occasion.

 

I look at this bill as a compromise. I never thought that a true 1 payor system would ever succeed and while some progressives might be upset at such an idea, I realistically point to the idea that about 42% of this country thinks that this bill is too liberal to begin with.

 

I do not think that come November this will be Waterloo. I see the premise that conservative lawmakers are taking, as a great way to raise funds for the mid-term elections.

 

I would encourage people to become informed about this bill and read on it’s provisions. For many out there, your healthcare will stay the same. I would also remind you that the Republican plan out there would strip employer based coverage and make you purchase this on your own, which would, in turn, be a much more drastic approach to healthcare overhaul. You would lose all benefits that your employer is presently covering and in many cases pay a significantly higher rates. There is also the danger that these healthcare insurance companies would reside in states where looser regulations could mean a drop in coverage.

 

And while I do believe that Tort Reform is necessary I do not believe it will solve every dilemma in healthcare.

 

I also do not see eye to eye with the social conservatives as a whole who have chosen a path that sees God through a different pair of glasses than I do. Jesus was around during a time when government failed to protect many of it’s citizens and I truly believe that Judeo-Christian principles are necessary in providing social justice to all beings. I really do not think that Jesus would want insurance companies denying coverage or setting pre-existing conditions.

 

Don’t get me wrong, there are plenty of uncertainties with this bill but as a whole it is much better than our current system. Those abnormalities can always be worked out once they go into place and we see this plan in action.

 

As I have grown older I have become much more disillusioned with my conservative counterparts in life. Greedy business practices are the culprit of our economic demise, something that will take years to rebound from. But you see people through a different lens.

 

So I guess in R.E.M. terms, should we talk about the weather?

I think that the first question you have to ask yourself is why you are supporting Hillary Clinton.

Are you supporting her because she is a female?

If so then what does that mean to you? Do you believe that her being female that she will support women’s rights? If so what exactly does that mean?

Having anger or spite over an election that was clearly lost is not the same as feeling that you have somewhat been stolen the election which was clearly not the case. Say what you want about Florida and Michigan but both of those states should and will not come into play. This is nobody’s fault. This was not Barack’s fault or even the Democratic Parties fault.

If it is about her being a woman then is it all about that or something else? Is the belief that she will support womens rights and if so will John McCain do a better job of this in the future?

Voting for spite based on an election Clinton clearly lost is not smart when it comes to your future as well as your family and friends.

As an American, for the past 35 years I have seen our nation grow more divisive with each passing year. Red states and Blue states seem to have walls built up and rather than tearing them down we constantly fight and bicker rather than believe that the other side has any logical argument.

As an American, I have always considered myself a bit of a moderate Democrat. As I peruse the three final candidates for election on the Democratic end I want to bring a candidate into office that I believe will be able to work with both sides of the aisle and to bring upon a new chapter in American history that does not look to divide this country but bring it together.

Our country has been wounded by the attacks not from 9/11 but the attacks that have gone on by both sides of the aisle that look to take down the other side with dirty politics.

Carolyn Kennedy wrote in an op-ed piece in the New York Times which described her feelings about Barack Obama as associating Obama with her father, John F. Kennedy. In my opinion, Obama is this person that can bring this nation back together.

On the issues alone, Clinton, Obama and Edwards are all pretty similar.  So for me it came down to who I thought was not just going to inspire me but inspire someone that does not always agree with me.

One of the things that I have noticed in the past 8 years of Republican leadership is that either you are “Good” or you are “Evil”, you are “For Us or you are Against Us”. This divisiveness has created more harm than good. It has taken our friends and made them our enemies.

That is the element that our great nation needs. That is the element that needs to heal our country of its differences and inspire and truly lead our great nation. As I listen to Barack Obama speak as he did last night in South Carolina I am reminded that even we as individuals have become just as divisive and willing to not listen to the other side. Here is a man that has passed this message wherever he has gone, since catapulting himself in the national spotlight nearly 4 years ago when he spoke at the Democratic National Convention.

What has strengthened my resolve for Barack Obama is how he has handled the attacks by both Hillary and Bill Clinton who have tried to paint him as a Black Candidate rather than a candidate. I have always felt support for a candidate not based on their race, gender or ethnicity but their ideas and values.  The last two months have seen me as well go from having a positive opinion of both Hillary and Bill to an overall negative one.  It has gotten to the point where I have questioned whether I could vote for Hillary in the general election if she was the Democratic candidate.

I believe that Hillary Clinton is an intelligent viable candidate for the Presidency.  In the manner in which her husband was a former president would have offered this country the unique experience of rebuilding the country.  What has discouraged me is Bill Clintons lack of empathy this election cycle that has turned me against both of them. I was a big Clinton supporter for years but cannot get past this element that is threatening to divide the Democratic party.

In talking with other people what really has strengthened my beliefs is the idea of so many young people that have been inspired by Barack Obama. I speak to the older generations specifically about this of who do you want to lead our country. Think to yourselves not what your vote means to you but what it means for your children and grandchildren. We see a leader that has different ideas and values of what it means to be president in Obama.

I have listened to many people get driven to tears listening to his speeches which reminds me that politicians still have the ability to move and influence rather than bicker and fight. Barack Obama is the first candidate that I felt has spoken to me and that is why I am supporting him for President of the United States.

Mitt Romney wants to be the religious conservative that is not a religious conservative.  Mormonism has also become a very difficult issue for Americans and Romney to deal with. While Kennedy might have had problems being a Roman Catholic in the 60s, I think that the difference between Catholicism and Mormonism is that Mormonism is slightly askew in its beliefs, especially the issue of Polygamy, as well as some of the views of the Mormon Religion which is not truly Protestant or Catholic but falls outside both of these groups. Mormons in their own way are looked at as a “Cult” in some sects of the Christian faith and by these same people not really considered Christians whatsoever.

While all three groups do share the bible as a source for their beliefs, Mormons also use the book of Mormon and that is where the problems truly exist.

How do you pretend to be a man of faith within a party of faith that does not trust your faith?

I am not sure who to believe anymore, whether, the CTA should just go away completely, whether IL Speaker Michael Madigan is right, Chicago Mayor Richard Daley or Rob Blagojevitch.

 First things first, Blago is short on balls and has shown already that he is weak when playing with these powerful people. I can only imagine that a Governor like Jim Thompson or Edgar would have the same problem. Secondly, what is the problem with the infighting that is going on amongst Democrats. With all the power they are unable to come up with a solution to this crisis and the sad part is that now there is talk about the CTA striking over the states “Pussyfooting” around this issue.

The last we hear, both Daley and Madigan walked out of the meetings held by Blagojevitch in regards to the CTA feeling that the meetings had more to do with other things rather than the transit problem in Chicago.

And as I stood in the bus in my morning commute as the regular pedestrian members of the Chicago population became sardines I looked at the bus driver trying to hold it all together in a crowded bus and thought, this is not the problem of anyone in this bus and we have been left in a situation where there is consistently not enough transportation and too much complaining.

This should be something that we could take care of pretty quickly but instead we are going to find out come January many of us will be stuck in the cold waiting endlessly for a bus that will take us twice as long to get to work and Chicagoans are going to get angry and fight back.

 

The Abraham Lincoln DilemmaAbraham Lincoln is probably our most fascinating president if for only the way that Lincoln ran the country during the Civil War. No other president before or after could in part keep this country together without going through the means at which he did it. However, by doing so, he left the country open to leaders who have used him as an example to further their own power, aka, President Dubya. The issue of secession is a large one in part because no other president before that believed they had the power to do anything about it. In fact, the entire idea of secession from the Union was purposefully kept out of the Constitution for this very purpose. Realize that when the framers of the constitution met, they wanted a strong union, especially Hamilton who envisioned America to be an Empire rather than a collection of states. By framing the constitution without an “Out Clause” the states were in many regards forced to comply with the federal government. While there were still rights within each state, this championed however the idea of a strong unified government. Some people,  Libertarians especially, point blame at Lincoln for enacting war against the South for seceding but if they have no constitutional merits for seceding how can they? In effect they were breaking the constitution for doing exactly this. It is “Constitutionally Plausible” for instance in Canada to secede.  Presidents before this avoided the issue entirely by claiming that the Constitution did not give the President any powers in preventing this from happening. Lincoln believed that his ultimate goal was to keep the nation whole and not split. There have been instances where some have felt that Lincoln went too far, in his suspension of Habeas Corpus in 1861 the loss of Freedom of Speech due to militant action was, in his opinion, dangerous enough that he felt it necessary to do so. We avoid this topic in many history books when discussing Lincoln and some might look at this issue as being the impetus that Presidents have used since then to protect the nation. The question of course when dealing with the constitution is keeping in context the time and place for it. The Constitution was created to safeguard against individuals freedoms being trampled upon at the same time there is the fear factor of Terrorism. However, even the term “Terrorism” is more a byproduct of the times and sends a different message to the public than just being a “Militant”. Our American forefathers were terrorists. Washington was a terrorist as was Hamilton. The Boston Tea Party was the most famous terrorist act this side of 9/11. The aspect of this small nation at the time defeating the British Empire is ‘Terrorism’. There always will be terrorism as I see it. Greenpeace is a terrorist organization as I see it. Every President since Lincoln has impeded on these actions with the exception of a minor few that did not. Some others like FDR might have gone beyond the scope and detail of their duties but at the same time they did so with the idea of strengthening the United States. The Lincoln dilemma however looks at the increased powers of what the President and Chief Executive can do. While we are in a “War” that war does not threaten the sanctitude of the United States which was what Lincoln had fought against.  As this nation has pushed farther into the idea of becoming a Police State, we have used “Fear” as a means to push policies rather than logic.  And rather than sitting down with our enemies we have cut off negotiations which has only made things worse. It was Bush that labeled Iraq, Iran and North Korea the “Axis of Evil”, a term that is consistent with other aspects of this Republican controlled White House. They forced us into a war that should have never begun and we are paying the price for it.

Lincoln is fascinating if only for this reason. His legacy even with his low popularity was due to his measures that he created.  Are we going to feel the same way about Bush in 50 years? I doubt it.

Face the facts, based on the following facts from the CTA they are planning on cutting over 82 Bus Routes which is over half the routes that travel the city streets. I am not sure if the lawmakers are aware that some of these routes are major arteries of travel amongst the citizens of the City Of Chicago.  While this is one of the first times in history I have been pushed to write a letter to all of my representatives, I just cannot see myself voting for any of them if something is not done. For the non-Chicagoan, I do not have a car, I do not need a car and I can live with the CTA. Yes, I am from the Wilco perspective that you can “Kiss and ride on the CTA”.

 

What I cannot live with is the aspect that nearly every bus that I take to work is going to be terminated come January 6, 2008 unless budgetary measures are made in the Illinois Legislature.

 

My immediate feeling is that this issue will close the book on Chicago’s 2016 Olympic Hopes. Fact is that I will write the Olympic Committee myself.

 

Transportation is the key to commerce and by cutting off transportation this city will just become an average city with a very disappointed population.

 

When I started this site up I thought I would write more about politics and I have found myself feeling more and more cynical about everyone within government. Maybe there is part of me that wants this to happen and maybe Government will wake up, cause if the CTA is cut, nobody is safe. Not even Daley.

As horrifying or atrocious that we see in Myanmar, we are reminded that technology is finally making the right impact. Rather than follow our rock stars and movie stars, real pictures of the despair that is going on in this world as trumped the national news spotlight the last week or so.

The image has a way of conveying much more than words can ever portray and technology will be a constant reminder for any country, government or other entity that they are being watched.

The theme from ‘1984’ has in many respects shown a dualistic role where the public is just as wary at the government as it of the public. There are enough cases over the years of police brutality on tape, photos coming from the Iraq war (see Abu Garaib prison), and other assorted events that have made their way onto YouTube, Flickr or some other site.

We are seeing a changing of the guard where the public are the real police and it will become even more challenging in the years ahead where more and more video and photos are in the hands of Joe Nobody rather than a news organization.

What is interesting is that the Promotional Pundits at ABC, CBS, NBC, CNN, FOX are following public interest rather than their own polls, that the real stories are not what they force feed us on a nightly basis but something else.

At the end of the day, we see very low approval ratings for our government as they are caught off-guard about what is expected and what the public wants.

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I like how the oil companies like to market these ideas and values to us as if they are Beyond Petroleum and seeking conscious alternatives whereby they are just as guilty as they always have been.  

The point to the corporation is to make money and not to improve and or help out society and for a company that made 6 Billion dollars last year, I do question the motives and thoughts behind this.  

Lake Michigan is such a beautiful natural resource for America we do not need any more excess pollutants than have already been added to the lake.